Pathway by Which Oral Cancers Invade the Mandible

  • To determine the need and extent of mandible resection:
    • It is essential to understand the pathway by which oral cancers invade the mandible
  • Primary carcinomas of the lip, buccal mucosa, tongue, and floor of the mouth:
    • Extend along the surface mucosa and the submucosal soft tissues:
      • To approach the attached labial, buccal, or lingual gingiva
    • From this point:
      • The tumor does not extend directly through intact periosteum and cortical bone toward the cancellous part of the mandible:
        • Because the periosteum acts as a significant protective barrier
    • Instead:
      • The tumor advances from the attached gingiva toward the alveolus:
        • In patients with teeth, the tumor extends through the dental socket into the cancellous part of the bone and invades the mandible in that fashion (Figure)
Tumor invasion of the dentate mandible occurs through
the dental socket to the cancellous bone and then to the alveolar canal.
  • In edentulous patients:
    • The tumor extends up to the alveolar process and then infiltrates the dental pores in the alveolar ridge and extends to the cancellous part of the mandible (Figure)

 

Tumor invasion of the edentulous mandible occurs
through the dental pores on the alveolar process to the cancellous bone
and then to the alveolar canal.
  • Thus even in patients with early invasion of the mandible:
    • A marginal mandibulectomy is feasible because the cortical part of the mandible inferior to the roots of the teeth:
      • Remains uninvolved and can be safely spared
  • In edentulous patients, however, the feasibility of marginal mandibulectomy depends on the vertical height of the body of the mandible:
    • With aging, the alveolar process recedes and the mandibular canal comes closer to the surface of the alveolar process:
      • As shown in the Figure, the resorption of the alveolar process eventually leads to a “pipestem” mandible in elderly patients
Vertical height and location of the alveolar canal in
dentate and edentulous mandibles.
  • The ability to perform a satisfactory marginal mandibulectomy in such patients is almost impossible:
    • Because the probability of iatrogenic fracture or postsurgical spontaneous fracture of the remaining portion of the mandible is very high:
      • Similarly, in patients who have received previous radiotherapy, a marginal mandibulectomy should be performed with extreme caution:
        • The probability of pathological fracture at the site of the marginal mandibulectomy in such patients is very high
  • When the tumor extends to involve the cancellous part of the mandible:
    • A segmental mandibulectomy must be performed
    • A segmental mandibulectomy also may be required in patients with massive primary tumors with significant soft tissue disease in the proximity of the mandible

Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

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• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

image-49

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

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• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

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#Arrangoiz #CancerSurgeon #HeadandNeckSurgeon #SurgicalOncologist #MountSinaiMedicalCenter #MSMC #Miami #Mexico

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